SAQ 321 – Paediatrics – suspected measles after travel exposure

Paediatrics – suspected measles after travel exposure.

a. Incubation

• Accept 6-21 days; median about 13 days.

b. Examination findings

• Koplik spots.
• Non-purulent conjunctivitis.
• Pharyngitis.
• Lymphadenopathy.
• Splenomegaly.

c. Investigations

• Nose/throat swab for PCR.
• Urine PCR.
• Blood serology for IgM and IgG.

d. Rash

• Cranio-caudal progression, typically starting on the face.
• Palms and soles are rarely involved.
• Maculopapular or morbilliform erythematous rash.
• Blanching is not required because the rash can become petechial later.

e. Complications

• Encephalitis.
• Pneumonia or bronchiolitis.
• Otitis media.
• Immune suppression.
• Bacterial superinfection.
• Subacute sclerosing panencephalitis.

f. Discharge advice

• Explain that measles is contagious, with highest risk from five days before until four days after rash onset.
• Keep him at home until at least four days after rash onset.
• Provide a follow-up plan for results.
• Warn about complications and expected clinical course.
• Contact tracing/public health advice as appropriate.